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1 MY DOCTOR MADE ME CRAZY: CAN A MEDICAL-MALPRACTICE PLAINTIFF ALLEGE PSYCHOLOGICAL DAMAGES WITHOUT MAKING CREDIBILITY THE ISSUE? BRENDAN T. BEERY * ABSTRACT In civil cases that include claims of psychological damages, attorneys should not confuse what is discoverable with what is admissible. Although a defendant may discover all information contained in the psychiatric or medical records of a plaintiff, in such a case, misusing that information to prey on the predispositions or stereotypes of a fact finder is inexcusable. When an attorney seeks to embarrass a plaintiff by interjecting details of psychological difficulties rather than rebutting a damages claim particularly in light of the evolving understanding of what it means to suffer from a mental disability then the attorney s purpose is unacceptable. This article explores one of the last isms that can be used to attack the credibility and character of a witness, especially when the witness is a plaintiff in a civil case: sanism. Courts must be vigilant in protecting the rights of plaintiffs who suffer psychological damages. Courts must also prevent attorneys from using the very harm caused by defendants in such cases from being used to attack or embarrass party opponents. * Brendan T. Beery is an associate professor at Thomas M. Cooley Law School the nation s largest, most diverse, and most innovative law school. He holds a B.A. degree from Bradley University and a J.D., summa cum laude, from Cooley. The author thanks his former client, Bruce Halverson, for his faith and fortitude. He thanks also his colleagues and friends, Dean Charles Patrick Cercone and Professor Dan Ray, for their support and encouragement.

2 322 THOMAS M. COOLEY LAW REVIEW [Vol. 27:2 TABLE OF CONTENTS I. INTRODUCTION II. THE HALVERSON CASE III. THE RULES OF EVIDENCE AS THEY RELATE TO PSYCHOLOGICAL RECORDS IV. THE PREJUDICIAL EFFECTS OF PSYCHOLOGICAL EVIDENCE V. THE PARAMETERS OF CROSS-EXAMINATION AS THEY RELATE TO RAISING OTHERWISE BARRED EVIDENCE VI. CONCLUSION I. INTRODUCTION A man walked into an ophthalmologist s office for routine radial keratotomy (RK) surgery. 1 The year was 1993; at that time, the moreadvanced Lasik surgery was still in its infancy and was not broadly accessible. 2 The RK procedure was supposed to give the man the benefit of normal vision without glasses or contact lenses. By the time the man left the ophthalmologist s office, he was blind in one eye. 3 He would undergo numerous corneal transplants, each of which would fail. 4 He would need 1. Definition of Radial keratotomy, MEDICINENET.COM, (last visited Jan. 18, 2011) (Radial keratotomy is [a]n eye surgery designed to flatten the cornea, reducing its optical power, to correct nearsightedness (myopia). In the procedure, incisions (cuts) are made in the cornea. The procedure is said to be radial because the incisions resemble the spokes in a bicycle wheel. ). 2. See Mike Selvon, The Advancement in Custom Wavefront Lasik Surgery, ARTICLESBASE.COM (May 21, 2008), Many people are familiar with the term laser eye surgery and know it to be a type of corrective surgery to help improve various vision impairments. Lasik has become a very popular solution for many people, since it became widely available about a decade ago, in the mid 1990s. Unlike older forms of eye surgery, Lasik does not necessitate cutting the eye with a surgical scalpel. Instead, lasers are used to do the job. Id. 3. See Transcript of Record, vol. 5 at 55, Halverson v. Garrett, No. D NH (Dickinson Cir. Ct. 1999). 4. See id. vol. 6 at 157, 159.

3 2010] MY DOCTOR MADE ME CRAZY 323 anti-rejection drugs that, as a side-effect, cost him his sanity. 5 He would litigate the issue of medical malpractice for thirteen years. 6 Two different juries found that the doctor who blinded him was not liable. 7 Both juries heard about the RK procedure and how it should be performed by any competent ophthalmologist. 8 Both juries were also regaled with tales of the man s behavior during psychotic episodes brought on by the anti-rejection drugs that he took with the hope that his body would accept a cadaver s cornea. 9 Why did two juries find for the doctor? Was it because they reached the untenable conclusion that a doctor who blinds a patient during a routine procedure is not liable for malpractice? Or was it because the juries were exposed to evidence of the man s psychotic behavior, causing them to view him as a deranged other who did not deserve their sympathies? The case described above, Halverson v. Garrett, is real. 10 It illustrates the dangers posed when a plaintiff alleges psychological damages in a complaint. And it undergirds the perception among many plaintiffs attorneys that a claim for psychological damages opens the door to virtually limitless questioning at trial about a client s psychiatric and medical records. The warnings to plaintiffs lawyers in civil cases have been many, and [o]ne fact has clearly emerged: by filing suit... seeking any form of compensation for psychic injury, a plaintiff runs a substantial risk that her current and past mental health treatment will become a focus of discovery and perhaps of the defense theory at trial. 11 Even the U.S. Equal Employment Opportunity Commission has stated, The claimant should be advised that as a general rule, the defendant will be able to probe in discovery and at trial with respect to all elements of the claimant s nonpecuniary compensatory damages claim. By including a... mental or emotional condition as an element of... damages, the claimant is essentially waiving any claim of... confidentiality with respect to evidence relevant to the 5. See id. at 30, vol. 8 at See Halverson v. Garrett (Halverson II), No NH, 2006 WL (Mich. Ct. App. Nov. 21, 2006). 7. See id. at *1. 8. See Transcript of Record, supra note 3, vol. 7 at See id. vol. 5 at 65, 68-69, 70-71, vol. 6 at 106, vol. 8 at Halverson v. Garrett (Halverson I), No , 2001 WL (Mich. Ct. App. Mar. 13, 2001); Halverson II, 2006 WL Deirdre M. Smith, An Uncertain Privilege: Implied Waiver and the Evisceration of the Psychotherapist Patient Privilege in Federal Courts, 58 DEPAUL L. REV. 79, 81 (2008).

4 324 THOMAS M. COOLEY LAW REVIEW [Vol. 27:2 nature and extent of the damages. This waiver may be especially troubling to claimants in the context of psychotherapy treatment. 12 This perception is likely one reason why [p]robably no type of injury is neglected by plaintiff s counsel as often as psychological injury. 13 But the question arises whether authority exists to support the perception that a claim for psychological damages opens the door for a defendant to exploit a client s psychiatric or medical information at trial; the perception itself seems to have become governing law, likely leaving many instances of such exploitation, and even attorney misconduct, unchallenged. 14 The literature on this issue is sparse. When it comes to the question of defense counsel s use of plaintiffs medical or psychological information, 12. U.S. EQUAL OPPORTUNITY COMM N, REGIONAL ATTORNEY S MANUAL pt. 2, II.D (2005), available at part2.pdf AM. JUR. 3D Proof of Facts 1, 8 (2008). For a more troubling explanation, see Michael L. Perlin, On Sanism, 46 SMU L. REV. 373, (1992) [hereinafter Perlin, Sanism]. The author suggests that attorneys who represented mentally disabled clients were unwilling to pursue necessary investigations, lacked... expertise in mental health problems, and suffered from rolelessness, stemming from near total capitulation to experts, hazily defined concepts of success/failure, inability to generate professional or personal interest in the patient s dilemma, and lack of a clear definition of the proper advocacy function. As a result, counsel... functioned as no more than a clerk, ratifying events that transpired, rather than influencing them. Id. at 404 (quoting Michael L. Perlin & Robert Sadoff, Ethical Issues in the Representation of Individuals in the Commitment Process, 45 LAW & CONTEMP. PROBS. 161 (1982) (alterations in the original)). 14. Indeed, it is illustrative that in Halverson, the court stated, Plaintiffs argue that they were denied a fair trial because of defense counsel s repeated emphasis and injection, through argument and cross-examination, of irrelevant information concerning details of plaintiff s psychotic behavior, information which plaintiffs contend was irrelevant and highly prejudicial because it was designed to inflame and prejudice the jurors, thereby distracting them from the merits of the malpractice claim. We agree. Plaintiffs concede that no objection was made to these comments and evidence, and that their own attorney raised the issue of plaintiff s psychiatric condition during her opening statement and questioning, because plaintiff s psychiatric condition was relevant to the question of plaintiff s damages. Halverson I, 2001 WL , at *1 (emphasis added).

5 2010] MY DOCTOR MADE ME CRAZY 325 the great weight of scholarship centers on waiver, express or implied, of the physician patient privilege for purposes of discovery, especially in civilrights or sexual-harassment cases. 15 This Article examines the exploitation of psychological damages by defense counsel at trial and challenges the perception that a claim for such damages allows defense counsel to use a plaintiff s psychological past to distract the fact finder from the merits of a case. In any action in which a plaintiff specifically alleges a mental injury or a psychiatric disorder as an element of damages, a defendant will be entitled to some or all of the medical and psychiatric records of the plaintiff. 16 Whether such records are discoverable in cases specifically alleging psychological damages is not seriously in dispute. But confusion seems to have arisen between the rules of discovery and the rules of admissibility: a defendant s acquisition of psychiatric records in discovery is not a license (as seems to have been assumed by some) to raise detailed and embarrassing information obtained from those records at trial and in front of a jury. Part II of this Article provides a detailed account of the Halverson case. Halverson involved three trials and two appeals. 17 Both of the appeals resulted in unpublished opinions from the Michigan Court of Appeals. 18 Although the case carries limited precedential value, I will discuss it in detail because, as the reader will see, a better illustration of the problem addressed in this Article could scarcely be imagined. The case is a perfect exemplar of the hazards attendant to a defense lawyer s assumption that all that is discoverable is also admissible. 19 Part III examines the rules of evidence and concludes that when evidence of psychotic behavior relates to episodes that occurred after, and allegedly as the result of, the injury alleged in a complaint, the evidence is 15. Smith, supra note 11, at 80-86; see also Alvin O. Boucher, Implied Waiver and Psychotherapist Patient Privilege in North Dakota Medical Malpractice and Personal Injury Litigation, 83 N.D. L. REV. 855 (2007). 16. See MICH. CT. R (A)(1); MICH. CT. R (B)(2). It is the rule in Michigan that any claim beyond a claim for economic damages paves the way for discovery of the medical and psychiatric records of the claimant. See Hyde v. Univ. of Mich. Regents, 575 N.W.2d 36, 42 (Mich. Ct. App. 1998). Michigan s inclusive rule in this regard does not accord with the rule in other states; many jurisdictions hold that general claims of emotional suffering do not open the door to discovery of all medical and psychiatric records. See LeGendre v. Monroe County, 600 N.W.2d 78, 87 (Mich. Ct. App. 1999). 17. See Halverson I, 2001 WL ; see also Halverson II, No NH, 2006 WL , at *1 (Mich. App. Nov. 21, 2006). 18. See Halverson I, 2001 WL ; Halverson II, 2006 WL I was the attorney who handled the first appeal in the case.

6 326 THOMAS M. COOLEY LAW REVIEW [Vol. 27:2 not relevant to a plaintiff s credibility or perceptions of events that preceded or precipitated the injury. In other words, although an attorney may elicit testimony to show that a plaintiff s claim of psychological damages is not to be believed, the attorney may not suggest that a plaintiff is not to be believed because the plaintiff suffered psychological damage. To allow an attorney to make such an argument, especially when the psychological damage was allegedly caused by the conduct of the defendant in the first place, would be to seriously undermine any plaintiff alleging psychological harm as an element of damages. Part IV applies rules of evidence regarding prejudice and analyzes whether evidence of psychotic episodes resulting from an injury alleged in a lawsuit is more prejudicial than probative. Borrowing from the work of another scholar, Part IV of the Article posits that prejudicial evidence is evidence that is likely to cause the finder of fact to commit inferential error. 20 Applying this approach, the Article concludes that evidence of psychotic perceptions or episodes is likely to cause inferential error. This is so because jurors are likely to conclude that people who see things that are not real have no credibility. 21 Jurors are also likely to conclude that evidence of psychotic behavior is representative of a plaintiff s behavior or personality at all times. 22 Part V examines the question of whether evidence that is inadmissible because it is irrelevant or prejudicial might nonetheless be explored during cross-examination, because an attorney may probe all information regarding a subject to which opposing counsel has opened the door. Part V concludes that cross-examination is limited by the rule that an attorney may not intentionally divert a jury s attention from the merits of a case. 23 Part V also concludes that an attorney may not question a plaintiff about psychotic episodes to explore the animus, bias, or ulterior motives of a plaintiff because a plaintiff s conduct during psychotic episodes is not properly characterized as representative of any predisposition or ulterior motive for filing a claim. Boiled down to its essence, this Article ultimately concludes that the fact that a person suffers from psychotic episodes is not a proper foundation for the inference that the person who suffered from the episodes lacks credibility. Courts should be vigilant in protecting plaintiffs who 20. Victor Gold, Covert Advocacy: Reflections on the Use of Psychological Persuasion Techniques in the Courtroom, 65 N.C. L. REV. 481, 484 (1987). 21. Cf. id. at 503 (suggesting that witness credibility may distract jurors from judging the actual strength of the evidence being presented at trial). 22. See Halverson I, 2001 WL , at * See Wischmeyer v. Schanz, 536 N.W.2d 760, 766 (Mich. 1995) (quoting Kern v. Saint Luke s Hosp., 273 N.W.2d 75, 81 (Mich. 1978)).

7 2010] MY DOCTOR MADE ME CRAZY 327 have suffered psychological difficulties from being harassed or embarrassed in open court. II. THE HALVERSON CASE In Halverson, the plaintiff sued the defendant, his ophthalmologist, for perforating his cornea during RK surgery. 24 The plaintiff claimed that the doctor violated the standard of care for informed consent by misrepresenting the risks associated with RK surgery. 25 The plaintiff also claimed that the doctor violated the standard of care for the surgical procedure by perforating his cornea and piercing the iris and lens of his eye, causing trauma that ultimately required a corneal transplant. 26 The plaintiff in Halverson conceded that his own attorney introduced evidence of psychosis because his psychiatric condition was part of his claim for damages. 27 But the plaintiff also claimed that defense counsel went too far in questioning the plaintiff and the plaintiff s psychiatrist about episodes of psychosis, using the information to embarrass the plaintiff and destroy his credibility. 28 The defense counsel s strategy included asking the plaintiff the following series of questions: whether the plaintiff blamed the doctor for his mother s heart attack; 29 whether he had ever sued a Wisconsin power company for damaging his home in Wisconsin; 30 whether the plaintiff was accusing the hospital of falsifying records; 31 whether the plaintiff had ever threatened to sue the police officer, who served a personal-protection order on the plaintiff, for misconduct or brutality; 32 whether the plaintiff had ever told anyone that the same officer was a dirty cop ; 33 whether the plaintiff had ever told anyone that the officer was involved in a drug ring; 34 whether the plaintiff had ever told anyone that the doctor controlled the police force; 35 whether the plaintiff had ever told his psychiatrist that he had thought about spray painting the doctor s office building; 36 whether the 24. Halverson I, 2001 WL , at * See id. at * Id. 27. Id. at * See id. at *1, * See Transcript of Record, supra note 3, vol. 7, at See id. at Id. at Id. at Id. at Id. at Id. at Id. at 174.

8 328 THOMAS M. COOLEY LAW REVIEW [Vol. 27:2 plaintiff had ever told anyone that the doctor was a drug runner; 37 whether the plaintiff had ever accused the doctor of planning to kill him; 38 whether the plaintiff had purchased equipment to make recordings of phone calls, and had secretly taped conversations with the doctor; 39 whether the plaintiff considered himself a trained fraud investigator; 40 whether the plaintiff had a certain level of security clearance from the government, whether he could prove that he had top-secret security clearance, and whether his security clearance had been revoked like they did to Jay Robert Oppenheimer during the Los Alamos Project ; 41 whether the plaintiff had ever been the subject of an FBI background check; 42 whether the plaintiff had told FBI investigators that he had used LSD; 43 whether the plaintiff considered himself a biblical scholar and had referred to the Bible s refrain of an eye for an eye, a tooth for a tooth as justification for wanting to poke the doctor s eye out with a hot poker when he spoke to his psychiatrist; 44 whether the plaintiff was aware that, according to Matthew 5:38, the concept of an eye for an eye was pagan and that we should instead turn the other cheek; 45 whether the plaintiff had ever told someone at a hospital that he wanted to murder the doctor; 46 whether, during the course of a fraud investigation, the plaintiff had accused an employer of contractor fraud and cited a portion of the U.S. Code in support of his allegations, whether his report of fraud had endeared him in the eyes of his employer, and whether the plaintiff had reported the fraud to the federal government rather than just internally to his employer; 47 whether the plaintiff had ever made allegations that the prosecutor was just a puppet for the doctor; 48 whether the plaintiff had ever accused the prosecutor of having a conflict of interest involving part ownership of a business called the Golden Nugget, and whether, with all [the plaintiff s] resourcefulness, the plaintiff had ever checked to see the so-called public records that would prove that the prosecutor is a part owner of the Golden Nugget ; 49 whether the plaintiff had penned a letter to defense counsel in which he likened himself to 37. See id. at See id. at , Id. at 185, Id. at Id. at Id. at Id. 44. See id. at Id. at Id. at Id. vol. 8 at Id. at Id. at 26.

9 2010] MY DOCTOR MADE ME CRAZY 329 Columbo and stated that others may have thought he was crazy, too; 50 whether the plaintiff remembered writing letters to his psychologist in which he opined that he had been victimized by yet another criminal attack ; 51 and whether the plaintiff remembered telling his psychologist that he was robbed in Tampa, Florida and called police, and the police asked him if anyone was hurt, if he had the suspect in custody, and if there was more than $1,000 taken, and that the police told him that they could not be bothered and hung up on him. 52 Defense counsel went so far as to ask the plaintiff whether he had once told his psychiatrist that he was upset about going to a public beach and being propositioned by a forceful queer. 53 Defense counsel also asked whether the plaintiff had once told his psychiatrist that he was upset about two men French kissing and fondling each other in front of him at Disneyland and whether he had told his psychiatrist that ever since that vacation, he did not feel safe anywhere. 54 These examples merely touch on the innumerable questions asked about the plaintiff s background and perceptions. Defense counsel questioned the plaintiff s psychiatrist in much the same way that he questioned the plaintiff. 55 Defense counsel also asked about the plaintiff s family history, including whether his parents had been separated at any time and whether his father was abusive. 56 Defense counsel got most of the information underlying the questions above from notes obtained from the plaintiff s psychiatrist. 57 In the plaintiff s first appeal, the Michigan Court of Appeals held that the defense attorney s exploration of the excruciating and sordid details of the plaintiff s psychotic episodes was designed to inflame the jurors and divert their attention from the merits of the case. 58 The court reversed the jury verdict and remanded the case for a new trial despite the failure of the plaintiff s trial attorney to object and preserve the issue of attorney misconduct. 59 The court concluded that the quantum of 50. See id. at Id. at Id. at Id. 54. Id. 55. See id. vol. 5 at See id. at See generally id. 58. Halverson I, No , 2001 WL , at *3 (Mich. Ct. App. Mar. 13, 2001). 59. Id.

10 330 THOMAS M. COOLEY LAW REVIEW [Vol. 27:2 misconduct in Halverson satisfied the plain-error standard, which is applied to unpreserved error. 60 The Halverson case is unpublished and therefore lacks precedential value. 61 Nonetheless, it raises interesting questions. Generally, once counsel has put a plaintiff s psychiatric condition at issue as an element of damages, the opposing party is permitted to fully explore the extent of those damages and question the plaintiff about the legitimacy of the claim. 62 Furthermore, once a party has opened the door to a subject, the opposing party is generally entitled to fully explore that subject. 63 Finally, it is well settled in Michigan that the scope of cross-examination is broad: an attorney may discredit witnesses by attacking their credibility and exploring whether the witnesses testimony is colored by some animus, bias, or ulterior motive. 64 On the other hand, attorneys are expected to 60. Id. at * MICH. CT. R (C)(1). 62. Hyde v. Univ. of Mich. Regents, 575 N.W.2d 36, 42 (Mich. Ct. App. 1997). 63. Lewis v. LeGrow, 670 N.W.2d 675, 696 (Mich. Ct. App. 2003) ( [D]efendant s disclaimer of knowledge concerning emotional distress also opened the door to counsel s cross-examination concerning defendant s own claim for emotional distress because it had a bearing on defendant s credibility. ). 64. Powell v. Saint John Hosp., 614 N.W.2d 666, 670 (Mich. Ct. App. 2000). In Powell, the court stated as follows: Evidence that shows bias or prejudice on the part of a witness is always relevant. Accordingly, [t]estimony... which touches the bias or interest of the witness[ ] is always admissible, and can be shown upon his cross-examination, and, if denied by him, can be proven on rebuttal; the proper foundation being laid for such proof. As our Supreme Court explained over a century ago: It is true that where a witness is cross-examined on matters purely collateral, the cross-examiner cannot inquire of other witnesses whether the answers are truthful, because the inquiry would open irrelevant issues. But the interest or bias of a witness has never been regarded as irrelevant. It goes directly to his credit, and must determine with the jury how far facts depending on his evidence are to be regarded as proven. A party cannot be compelled to put up with the statements of a witness concerning his own interest or personal relation to the case and parties, where it becomes necessary to know his position.... The administration of justice would be very defective if every witness could, without contradiction, make himself out impartial and disinterested, and run no risk of exposure. Id. (alterations in original) (internal citations omitted).

11 2010] MY DOCTOR MADE ME CRAZY 331 refrain from embarrassing or badgering witnesses and from disparaging opposing parties. 65 The Halverson case represents a collision between these principles and begs the question: when a claim for damages includes an element of psychological harm, where is the line between permissible questioning about relevant evidence and impermissible questioning designed to embarrass a party and distract the finder of fact? III. THE RULES OF EVIDENCE AS THEY RELATE TO PSYCHOLOGICAL RECORDS Some plaintiffs attorneys omit claims of mental or emotional injury from their complaints, recognizing that allegations of mental or emotional distress may open the door to the discovery of unflattering information about their clients. 66 Applying Federal Rule of Civil Procedure 35, which regulates when a court may order the mental or physical examination of a party, one federal court has crystallized the general rule that seems to be emerging: courts allow the discovery of detailed psychiatric information when 1) there is a separate tort claim for emotional distress, 2) the plaintiff alleges that he suffers from a severe ongoing mental injury or a psychiatric disorder, 3) the plaintiff will offer expert testimony to support the claim, or 4) the plaintiff concedes his mental condition is in controversy. 67 In any action in which a plaintiff specifically alleges a mental injury or a psychiatric disorder, a defendant will be entitled to all of the medical and psychiatric records of the plaintiff. 68 Whether such records are 65. See Bd. of Cnty. Rd. Comm rs v. GLS LeasCO, Inc., 229 N.W.2d 797, 800 (Mich. 1975). While a lawyer is expected to advocate his client s cause vigorously, parties are entitled to a fair trial on the merits of the case, uninfluenced by appeals to passion or prejudice. Id. (quoting Layton v. Cregan & Mallory Co., 257 N.W. 888, 891 (Mich. 1934)). 66. Smith v. J.I. Case Corp., 163 F.R.D. 229, 230 (E.D. Pa. 1995). But see MICH. CT. R (A)(1), 2.314(B)(2). It is the rule in Michigan that any claim beyond a claim for economic damages paves the way for discovery of the medical and psychiatric records of the claimant. Hyde, 575 N.W.2d. at 42. Michigan s inclusive rule in this regard does not accord with the rule in other states; many jurisdictions hold that general claims of emotional suffering do not open the door to discovery of all medical and psychiatric records. See LeGendre v. Monroe County, 600 N.W.2d 78, 87 (Mich. Ct. App. 1999). 67. LeGendre, 600 N.W.2d at 88 (quoting Smith, 163 F.R.D. at 230); see also Bridges v. Eastman Kodak Co., 850 F. Supp. 216 (S.D.N.Y. 1994). 68. See, e.g., In re Miller, 585 N.E.2d 396, (Ohio 1992) (holding that the filing of a lawsuit that puts a person s physical or mental condition at issue waives a claim of privilege); McCoy v. Maxwell, 743 N.E.2d 974, 976 (Ohio Ct.

12 332 THOMAS M. COOLEY LAW REVIEW [Vol. 27:2 discoverable in cases alleging psychological damages is not seriously at issue. 69 Confusion might arise when a defense attorney takes allegations of psychological injury as a license to raise as well as discover detailed and embarrassing information contained in the medical and psychiatric records of a plaintiff who alleges psychological damages. The reticence of plaintiffs attorneys to even allege emotional or mental damages may be the result of the boldness of defense attorneys who insist that such allegations will lead to a thorough exploration of a plaintiff s most intimate secrets in open court. The panel in Halverson, however, did not accept the argument that the defense counsel was entitled to explore the excruciating and sordid details of the plaintiff s conduct simply because the plaintiff had alleged psychosis as an element of damages. 70 Although the court did not squarely address the issue in its opinion, it might have rejected the defendant s argument because of the difference between rules of discovery and rules of admissibility. 71 A misunderstanding about this distinction is likely the preeminent cause of the perception that a claim for psychological damages opens the door to limitless questioning at trial about a plaintiff s psychiatric and medical records, and courts should, therefore, articulate that different rules govern the discoverability and admissibility of information regarding a party s psychological records. A defendant might argue that because a plaintiff has alleged psychosis in the complaint, and because a plaintiff s attorney might reference psychological damages in the opening statement, defense counsel is entitled to thoroughly explore all information contained in, or even suggested by, the psychiatric records in possession of the parties. The leading case on this issue in Michigan appears to be Hyde v. University of Michigan Regents. 72 In Hyde, the plaintiff sued his employer for racial discrimination and alleged in his complaint that he suffered App. 2000) (holding that a party did not waive psychologist patient privilege but would have if the party had alleged emotional distress). 69. See MICH. CT. R (B)(1) ( Parties may obtain discovery regarding any matter, not privileged, which is relevant to the subject matter involved in the pending action. ). 70. Halverson II, No NH, 2006 WL , at *2 (Mich. Ct. App. Nov. 21, 2006). 71. Compare MICH. CT. R (B)(1) ( Parties may obtain discovery regarding any matter, not privileged, which is relevant to the subject matter involved in the pending action. ), with MICH. R. EVID. 403 ( Although relevant, evidence may be excluded if its probative value is substantially outweighed by the danger of unfair prejudice, confusion of the issues, or misleading the jury.... ) N.W.2d 36 (Mich. Ct. App. 1997).

13 2010] MY DOCTOR MADE ME CRAZY 333 mental anguish, outrage, embarrassment and humiliation. 73 Under Michigan law, [w]hen a mental... condition of a party is in controversy, medical information about the condition is subject to discovery. 74 In Hyde, because the plaintiff had alleged mental suffering, the defendant sought discovery of the plaintiff s mental-health history. 75 The plaintiff refused to comply with the defendant s discovery request, claiming the physician patient privilege. 76 Michigan Court Rules provide: [I]f a party asserts that the medical information is subject to a privilege and the assertion has the effect of preventing discovery of medical information otherwise discoverable..., the party may not thereafter present or introduce any physical, documentary, or testimonial evidence relating to the party s medical history or mental or physical condition. 77 In Hyde, the trial court permitted the plaintiff to testify about certain mental and emotional difficulties even though the plaintiff had invoked the physician patient privilege. 78 The court of appeals held that this was error. 79 The court stated: Where... a plaintiff... seeks recovery for anything beyond economic damages..., we hold that he has thereby placed his mental condition in issue and consequently open to discovery. In order for a defendant to defend a claim for noneconomic damages, he must be permitted to determine, through discovery, whether factors other than the defendant s alleged misconduct may have influenced the plaintiff s emotional and mental condition. To preclude discovery of the plaintiff s mental or psychological history while permitting the plaintiff to testify regarding noneconomic damages, would deprive the defendant of a fair trial. Thus, if the plaintiff asserts the privilege to prevent discovery on this issue, the plaintiff 73. Id. at MICH. CT. R (A)(1). 75. Hyde, 575 N.W.2d at Id. 77. MICH. CT. R (B)(2). The Federal Rules of Civil Procedure have no counterpart to MICH. CT. R (B)(2). 78. Hyde, 575 N.W.2d at Id.

14 334 THOMAS M. COOLEY LAW REVIEW [Vol. 27:2 must withdraw, or the court must dismiss, any claim for noneconomic damages. 80 Defense counsel might cite the Hyde holding as a justification for questioning plaintiffs about information contained in their psychiatric and medical records. However, the Hyde holding does not support such an argument; the Hyde court found that all information regarding a plaintiff s psychological condition is discoverable not admissible when a plaintiff puts his mental or emotional condition at issue. 81 The holding reflects Michigan s liberal approach of allowing discovery regarding any information that might lead to admissible evidence at trial. 82 Different rules apply to discovery than to admissibility. 83 A party may obtain information reasonably calculated to lead to the discovery of admissible evidence even if the information sought will be inadmissible at trial. 84 Thus, to say that information is discoverable is not to say that it is admissible. The admissibility of embarrassing psychological information about a plaintiff is subject to the additional tests of relevance 85 and prejudice, confusion, or waste of time. 86 An attorney who intentionally interjects prejudicial evidence into the deliberations of the fact finder should not be allowed to use Hyde and its progeny as a defense; while Hyde stands for the proposition that a defendant may possess this information, it does not stand for the proposition that the defendant may use it at trial. By refusing to accept the ruling in Hyde as justification for introducing prejudicial information designed to divert the jury s attention from the merits of the case, the court distinguished between discoverable and admissible information. Defendants are not entitled to explore every conceivable episode of the psychotic conduct of a plaintiff during trial under the guise that the plaintiff has opened the door to such questioning by alleging mental or emotional harm as an element of damages. 87 It is clear that the rules of discovery do not entitle a defendant to raise all information regarding a plaintiff s psychiatric and medical records in 80. Id. at See id. (citations omitted). 82. See MICH. CT. R (B)(1). 83. Compare MICH. CT. R (describing the discoverability of medical records), with MICH. R. EVID (governing the admissibility of evidence). 84. See MICH. CT. R (B)(1). 85. See MICH. R. EVID. 401 (defining relevance); MICH. R. EVID. 402 (explaining the admissibility of relevant evidence). 86. See MICH. R. EVID. 403 (discussing various tests to determine when relevant evidence should not be admitted). 87. See id.

15 2010] MY DOCTOR MADE ME CRAZY 335 front of a jury. 88 The question remains whether such information can pass muster when evidentiary rules regarding relevance are applied. Relevant evidence is admissible, and irrelevant evidence is not. 89 Relevant evidence is any evidence that makes a fact at issue in the case more or less likely true than it would have been without the evidence. 90 The argument might be made that the psychiatric or medical records of a plaintiff are relevant in two ways. First, one might argue that the evidence is relevant as to damages; a detailed exploration of the evidence might be necessary to rebut a claim for damages or a claim of good health prior to an alleged injury. Second, one might argue that the evidence is relevant because it reflects upon the credibility of the plaintiff. 91 Neither argument justifies the admission of detailed psychiatric or medical records regarding the psychotic conduct of a plaintiff after and allegedly resulting from the injury alleged in the complaint. A defendant should not be permitted to question a plaintiff about psychotic behavior that occurs after, and as the alleged result of, the injury alleged in the complaint. In one case, the Michigan Supreme Court stated: Serious complaint is made of the court permitting defendant to show that in June 1911, plaintiff was an inmate of the psychopathic ward of the hospital at Ann Arbor, which is urged as error particularly prejudicial to plaintiff s claim for damages, because unfairly tending to minimize his testimony before the jury by the implication that he was mentally incompetent to testify rationally as to his injuries. The evidence upon this subject was developed in connection with plaintiff s cross-examination. Both he and his son had testified that prior to the accident his general health was good. He also testified that his memory was impaired as one of its results, while it was pretty good before. In that connection he was asked in crossexamination if he had been in the psychopathic ward at Ann Arbor in He replied that he was at Ann Arbor for treatment in 1911; he did not know what for; that he was in the hospital eight or nine days and then his sons brought him home. He denied being taken there by the sheriff on commitment by the probate court of Genesee 88. MICH. CT. R MICH. R. EVID MICH. R. EVID See discussion infra Part IV. This argument is more appropriately dealt with in a discussion of principles regarding cross-examination.

16 336 THOMAS M. COOLEY LAW REVIEW [Vol. 27:2 county, or that he was in the probate court in connection with any such proceedings. Following his denials and while upon that subject counsel for defendant introduced in evidence the files of the probate court relating to his commitment, as bearing generally on the condition of health prior to the accident and impeachment of plaintiff s own testimony of that condition. All testimony upon that subject was allowed over the objection that the same was incompetent and immaterial. This testimony was not introduced for the purpose of showing plaintiff of unsound mind and incompetent as a witness at the time of the trial, because previously so adjudicated. Neither would the fact that he was an inmate of the psychopathic ward of the Ann Arbor hospital for a short time... be evidence that he was then of unsound mind. Such was not defendant s claim or the avowed purpose of the proof. His sanity at the time of the trial and competency to testify were not questioned. In view of his and his son s testimony as to his previous good health, memory, ability to work and manage his farm, it was not incompetent to interrogate him on cross-examination as to any matters which might tend to throw light upon his former physical or mental condition as affecting his general health, efficiency, ability to work, and accuracy of memory formerly or at the time he was testifying. A reasonable latitude, in the discretion of the court, is always permissible along those lines in cross-examination of plaintiffs for damages ex delicto, particularly where the witness is evasive or irresponsive, and we do not find the discretion of the court was abused in the particular complained of. 92 Thus, if a plaintiff claims that the psychological condition is strictly the result of the injury alleged in the complaint, a defendant may introduce information to show that the plaintiff had psychological difficulties before the injury alleged in the complaint to rebut a claim that the damage was caused by the defendant. In Halverson, the court noted, There was no evidence that plaintiff was psychotic prior to taking anti-rejection drugs following the corneal 92. Griggs v. Saginaw & Flint Ry. Co., 162 N.W. 960, (Mich. 1917) (emphasis added).

17 2010] MY DOCTOR MADE ME CRAZY 337 transplant. 93 The court further noted, Plaintiff was taking anti-rejection drugs at the time of each psychotic episode. 94 Although a defendant may question a plaintiff about psychotic perceptions or episodes occurring before the psychosis that is alleged to be a result of a defendant s conduct, the court in Halverson stated that the psychotic episodes [at issue in Halverson] were not relevant to... [plaintiff s] informed consent claim, nor to his allegations of malpractice in the procedure, because except for damages the facts underlying those claims had been fully completed prior to plaintiff s first psychotic episode. 95 The court concluded that the specific facts of each episode were irrelevant to the substance of plaintiff s claims, and irrelevant to his credibility regarding those claims. 96 Because the plaintiff in Halverson was questioned at length about psychotic perceptions and episodes that occurred after the alleged injury rather than before it, the episodes about which the plaintiff was questioned were not relevant as rebuttal evidence to any claim of general good health prior to the injury alleged in the plaintiff s complaint. 97 Similarly, when a plaintiff makes no effort to hide evidence of mentalhealth problems, it is unnecessary to grill the plaintiff about the details of psychotic episodes to prove that the plaintiff did, in fact, suffer from psychotic episodes. 98 IV. THE PREJUDICIAL EFFECTS OF PSYCHOLOGICAL EVIDENCE Like the federal rules and the rules in most states, 99 the Michigan Rules of Evidence provide that evidence that is otherwise admissible may nonetheless be excluded at a court s discretion if the evidence is more 93. Halverson I, No , 2001 WL , at *3 (Mich. Ct. App. Mar. 13, 2001). 94. Id. 95. Id. 96. Id. 97. Id. ( [D]efense counsel s conduct of repeatedly injecting and emphasizing, in arguments and questioning, the sordid details of plaintiff s various psychiatric episodes requires reversal. The specific facts of each episode were irrelevant to the substance of plaintiff s claims, and irrelevant to his credibility regarding those claims. Those details, and counsel s arguments, were designed to inflame the jurors and divert their attention from the merits of the case, and from the issue of defendant s credibility which was pivotal to his defense. ). 98. See United States v. Gonzalez-Sanchez, 825 F.2d 572, 586 (1st Cir. 1987) (holding that evidence of mental incapacity was irrelevant when it did not affect the witness s ability to testify and when the trial court found no evidence that the witness deliberately concealed his mental-health history). 99. See, for example, MICH. R. EVID. 403 which is identical to FED. R. EVID. 403.

18 338 THOMAS M. COOLEY LAW REVIEW [Vol. 27:2 prejudicial than probative. 100 The rule requires an analysis of the propensity for a piece of evidence to make a fact at issue more or less likely true and a determination of the risk that it will distract from the jury s role of deciding the facts of the case. 101 Commentators acknowledge the difficulty in assessing when evidence is sufficiently prejudicial that, even if it is relevant, it should nonetheless be excluded because it is likely to confuse the jury and disrupt the jury s factfinding function. 102 Courts often focus on whether the evidence at issue is likely to elicit an emotional reaction from the jury, and a court may ask whether the evidence at issue is likely to elicit an emotional rather than logical thought process on the part of a jury. 103 This notion may have derived from the advisory committee s note to [Federal Rule] 403, which suggests that unfair prejudice is commonly caused by emotion. 104 Indeed, the Michigan Supreme Court has embraced the advisory committee s note as the proper framework for analyzing whether evidence is excessively prejudicial. 105 This approach has been discredited by some because it minimizes the importance of emotional thinking; one of the benefits of the jury system is that it interjects an element of human emotion into the cold logic of the law. 106 The approach has also been criticized because it leads to an ad hoc approach to applying Rule 403; an analysis about prejudice grounded solely on the question of whether evidence is emotional leaves courts without a meaningful standard and invites a virtually discretionless application of the rule. 107 One commentator has suggested an intelligent and workable approach to applying the rule of evidence regarding unfair prejudice. The commentator suggests that evidence is unfairly prejudicial to the extent it has a tendency to cause the trier of fact to commit inferential error. 108 Under this approach, error occurs when the jury incorrectly decides that evidence is probative of an alleged fact or event. 109 Inferential error also 100. MICH. R. EVID FED. R. EVID. 403 advisory committee s note Id Id Victor J. Gold, Federal Rule of Evidence 403: Observations on the Nature of Unfairly Prejudicial Evidence, 58 WASH. L. REV. 497, (1983) See People v. Vandervliet, 508 N.W.2d 114, 126 (Mich. 1993) 106. Gold, supra note 104, at Id Id. at Id. at 506; cf. Perlin, Sanism, supra note 13, at 378 ( These generalizations, based upon preconceived and misinformed opinions about the nature of difference,

19 2010] MY DOCTOR MADE ME CRAZY 339 occurs when the jury decides that evidence is more or less probative of a fact or event than it is. 110 An inference is [a] conclusion reached by considering other facts and deducing a logical consequence from them. 111 The inferential-error standard seems appropriate because it reflects the notion that courts should not admit evidence from which faulty conclusions might flow. Detecting unfairly prejudicial evidence requires focusing on the end product of the prejudice, not just on the process by which the prejudice might be created. 112 Thus, the best analytical framework is one that asks whether the evidence sought to be admitted is an appropriate foundation for the fact meant to be inferred. 113 The most effective analytical framework is not one that asks simply whether the evidence sought to be admitted is emotional. 114 Research in the field of cognitive psychology has identified tools for predicting inferential error. 115 Two important cognitive tools are heuristics and knowledge structures. An understanding of the manner in which heuristics and knowledge structures might be improperly employed by juries provides a basis for estimating the tendency of evidence to lead to inferential error. 116 [T]he representativeness heuristic can lead to error when jurors are asked to infer generalizations about a relatively large amount of data. In making such decisions, people are often insensitive to the amount of evidence they consider and tend to be swayed by a small amount of vivid, anecdotal information. [Political] [c]andidates often capitalize upon this tendency in political debate, where the wisdom of social programs is established not by reference to the mass of data demonstrating their value, but by reference to an absurdly small number of colorful case histories. The representativeness heuristic permits voters to infer incorrectly that, since the case histories have been taken from a larger mass of data, those histories must be representative of the mass. In the courtroom, this potential make little reference to actual information, and imply cause-and-effect relationships that do not exist. ) Gold, supra note 104, at BLACK S LAW DICTIONARY 847 (9th ed. 2009) Gold, supra note 104, at See id See id Id. at Id. at 511.

20 340 THOMAS M. COOLEY LAW REVIEW [Vol. 27:2 for error exists whenever the proper decision of an issue depends upon consideration of a large body of evidence, some vivid parts of which might be used to misrepresent the whole. 117 A case involving psychological damages and psychotic episodes as an element of damages is potentially confusing for a jury because it presents a jury with more than one set of a single person s behavior. In Halverson, for example, the court noted that some of the questioning challenged on appeal related to the plaintiff s conduct during psychotic episodes. 118 The court s opinion reflected a concern that the plaintiff s conduct during psychotic episodes would be seen as representative of the plaintiff s conduct at all times. 119 The same concerns would be implicated in any similar case. A defense attorney should not be allowed to suggest to a jury that a plaintiff s credibility is represented by a limited number of colorful episodes that occurred while the plaintiff was under severe psychological strain. In such cases, courts should be wary of the prejudicial potential of evidence that may direct the jury s attention away from the complexities and toward misleading similarities. 120 Michigan courts may have unwittingly crafted language that reflects a subconscious understanding of the representativeness heuristic. It is common for Michigan courts to state that an attorney may not intentionally divert a jury s attention from the merits of a case in an effort to unfairly prejudice a party. 121 As a method of causing unfair prejudice to an opposing party, attorneys have introduced true information intended to cause the jury to make a factual inference unrelated to the purpose for which the information was admitted. 122 To the extent that Michigan courts disallow the introduction of evidence that is intended to distract juries from the merits of cases, courts properly exclude evidence that misuses the representativeness heuristic Id. at Halverson II, No NH, 2006 WL , at *2 (Mich. Ct. App. Nov. 21, 2006) See Gold, supra note 104, at Id. at See Badalamenti v. Beaumont Hosp.-Troy, 602 N.W.2d 854, 861 (Mich. Ct. App. 1999) See Halverson I, No , 2001 WL , at *3 (Mich. Ct. App. Mar. 13, 2001) Cf. Gold, supra note 104, at (discussing how the representativeness heuristic can be used to direct attention from other evidence leading to a prejudicial effect).

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